Hales Group Limited - Norfolk

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.At our last assessment we did not rate this key question. At this assessment the rating is requires improvement. This meant people’s needs were not always met.

The service was in breach of legal regulation in relation to person centred care.

This service scored 46 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not make sure people were at the centre of their care and treatment choices and they did not work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

Most people and, or their relatives did not feel well informed about their care. People told us rotas showing who would attend their care call were not provided and the number of care workers they might see in a week could vary enormously as could the time of their support. Half the people we spoke with did not remember being asked for their views about the service. One relative told us, “Never seen a care plan. I just have a phone number. We’ve used them since November 2024. Somebody came from the office to discuss but there were no documents. No one has asked us anything since. So, no reviews.” Another person said, “At the beginning there was a plan, and I changed my plans as things improved. They listened. There was no formal review. I was able to say what I wanted.” People were clear that communication was poor with one person telling us “Communication with the office is not great. I’ve spoken to them a few weeks ago and wanted just 1 carer. I left a message and heard nothing for 2 weeks. I spoke to someone else who said they would pass it on. That was 3 days ago. I’m still waiting.” This demonstrates the provider did not put people at the centre of their care.

There were some shortfalls in how the provider understood the diverse health and care needs of people and their local communities, so care was not always joined-up, flexible or supportive of choice and continuity.

Staff felt alienated from their organisation and conflicted between their work life balance. People using the service reported shortfalls in their care impacting on their ability to remain independent and be a part of their community. 1 person told us “Carers are late for visits and never on time. It’s very confusing and it’s very difficult for [person].A call was missed yesterday and no one called to say. There have been three missed. It’s like a merry go round” Care was not joined up and was not tailored around individual needs.

The provider did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

People were not all aware of recent changes within the service or who was who and who did what. Most were not familiar with their care plan or the reviewing process or which staff were providing their care.

The service manager told us that people are given a service user guide/ welcome pack and this contained information of how people can complain. People told us they were aware how to complain but often had difficulty getting through or acknowledgment. The service told us that they would make information accessible to people's needs such as large print.

The provider did not always make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff did not always involve people in decisions about their care or tell them what had changed as a result.

People and relatives spoken with reported concerns about not being able to get through to someone in the office with calls unanswered or not returned. There were poor systems in place to routinely receive feedback from people, relatives and staff about their experiences. The service demonstrated asking for feedback. Despite this several relatives told us they had never been asked and staff told us supervisions and spot checks which could identify concerns or areas of good practice happened infrequently.

We reviewed the complaints log for both formal complaints and informal concerns. These did not always provide timely evidence of actions taken, or risk mitigation. There was not clear evidence of lessons learnt.

The provider did not always make sure that people could access the care, support and treatment they needed when they needed it.

People did not consistently receive the care they needed at a time they either chose or was previously planned. This was because the service did not have effective oversight to ensure people received their care calls at consistent and planned times

Staff and leaders did not always actively listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not always tailored in response to this. It was not always clear how people were supported to have their desired experiences and outcomes. There was inconsistent recordings in peoples care plans of their desired outcomes. Information around dementia and capacity was inconsistently recorded which meant we were not assured that people’s needs were clearly known. In addition, people using the service raised concerns about language barriers. The provider told us that where service users have raised concerns, including around communication they have responded promptly and constructively, offering solutions such as language support tools, visual aids, and interpreter access where appropriate in line with their accessible information policy. During our assessment we also identified issues with communication and recording which could increase the risk of information not being adequately captured and escalated.

However, we found examples where staff had worked with health care professionals for a person to achieve a better outcome. We found evidence of staff working alongside district nurses and occupational therapists.

People were not always supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

Changes in people’s needs were not always identified in a timely fashion making it difficult to plan for the future. Some care plans did include peoples wishes in relation to their ongoing care.

However, care plans showed us that do not attempt cardiopulmonary resuscitation (DNACPR) records were clearly logged. This is a decision made by a person alongside their doctor and any medical professionals. Staff told us they were aware if a person they were supporting had a DNACPR in place.